鼻中隔恶性肿瘤的手术径路探讨

Surgical management of nasal septum malignant tumor

目的:探讨鼻中隔恶性肿瘤的手术径路.方法:16例中,鼻侧切开术8例、鼻内镜下手术5例、面中部揭翻术2例、经腭入路1例.并对其病理学特征、手术径路及预后进行回顾性分析.结果:16例中,鼻中隔鳞状细胞癌7例、腺样囊性癌4例、恶性黑色素瘤3例、腺癌1例、黏液表皮样癌1例.术后随访1～10年,其中失访1例,死亡2例,带瘤生存3例,无瘤生存10例.病死率为12.5%,带瘤生存率为18.8%,无瘤生存率为62.5%.结论:鼻中隔恶性肿瘤手术径路应根据病变范围、患者年龄采取不同的术式.如病变局限于鼻中隔前下部或后部,则鼻内镜下切除;如病变涉及鼻中隔全部或累及鼻腔其他部位,则以鼻侧切开为宜;若患者年龄较小,则以面中部揭翻或经腭入路为宜.

Objective:To summarize the surgical treatment strategy of nasal septum malignant tumor.Method:Between 1993 October and 2003 Febrary,16 patients with nasal septum malignant tumor were treated.In a retrospective review,the pathological character,the operation reports,and the follow up data were analyzed,particularly with respect to the surgical approaches.Result:Ten male,37-79 years old, average 52.2 years old; 6 female,18-71 years old, average 58 years old.The pathology of nasal septum malignant tumor in our department were:seven cases with squamous cell carcinoma in(5 cases were primary, 2 cases were secondary),4 cases with adenoid cystic carcinoma (3 cases were primary, 1 case was secondary),3 cases with malignant melanoma,1 case with adenocarcinoma、1 case with mucoepidermoid carcinoma.Duration range was from 1 month to 7 months.The strategy of operation was that 8 cases with lateral rhinotomy,5 cases with endoscopy,2 cases with midfical degolving,1 case via ulvar pathway.All patients received postoperation radiation(30 Gy).After follow up for (1-10) years,1 case was undetected, 2 cases were dead(1 case with malignant melanoma, 1 case with secondary squamous cell cancer),3 cases survive with tumor(1 case with squamous cell cancer, 1 case with secondary adenoid cystic cancer, 1 case with malignant melanoma).Ten cases survive without tumor.The rate of death、survival with tumor and survival without tumor is 12.5%,18.8%,62.5%,respectively.Conclusion:The prognosis of nasal septum malignant tumor is related to operation,radiation and pathological character.The surgical approach to nasal septum malignant tumor is related to the size of the tumor and the age of patient.It classfies the following indications:①Endoscopic approach in cases with tumor localized in nasal septum;②Lateral rhinotomy in cases with extensive tumor infiltration of the nasal septum、nasal turbinates、or even sinus;③Midfical degolving or via uluar pathway in cases who are young persons.